Cancer News

Seattle Protocol No Better Than Less Intensive Method

-- Rick Ansorge

Friday, June 26, 2009

FRIDAY, June 26 (HealthDay News) -- In Barrett's esophagus patients with high-grade dysplasia, the intense Seattle biopsy protocol is no more reliable than a less intensive surveillance protocol at predicting early cancers at the time of esophagectomy, according to a study in the June Clinical Gastroenterology and Hepatology.

Revital Kariv, M.D., of the Cleveland Clinic, and colleagues studied 33 patients with high-grade dysplasia who underwent esophagectomy, 20 of whom received preoperative surveillance with the Seattle protocol (four quadrant jumbo biopsies every 1 cm) and 13 who underwent preoperative surveillance with the less intensive protocol (four quadrant biopsies every 2 cm).

Contrary to the researchers' expectation of a low rate of cancer in the Seattle protocol group, they found that 40 percent of the group had unsuspected intramucosal cancer compared to 30 percent of the patients who underwent the less intensive protocol. In addition, they observed preoperative mucosal nodularity in 50 percent of the postoperative intramucosal cancers from the Seattle protocol group and in 75 percent from the less invasive protocol group.

"These findings highlight the limitations of pursuing a strategy of continued endoscopic surveillance biopsies of patients with high-grade dysplasia, including the random nature of the surveillance biopsies, the limited surface area of the esophagus that can be sampled, the focal nature of early cancer in Barrett's esophagus, and interobserver variability among pathologists in the diagnosis of high-grade dysplasia," the authors conclude. "Intervention with either surgery or endoscopic therapy might now prove to be a more appropriate approach to address the problem of unsuspected cancer in these patients."